Chu Cherie, Tokumaru Sheri, Izumi Kara, Nakagawa Kazuma
a Department of Pharmacy Practice, Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, Honolulu, HI, USA.
b Department of Pharmacy, The Queen's Medical Center, Honolulu, HI, USA.
Int J Neurosci. 2016;126(1):62-6. doi: 10.3109/00207454.2014.993034. Epub 2014 Dec 27.
Not all patients with warfarin-related acute intracranial hemorrhage (ICH) achieve full reversal of international normalized ratio (INR) after the first dose of weight-based prothrombin complex concentrate (PCC). We sought to identify factors associated with anticoagulation reversal failure after the first dose of PCC.
Consecutive patients who were hospitalized with warfarin-related acute ICH at a tertiary center between 1 January 2010 and 31 December 2012 were studied. Anticoagulation reversal failure was defined as INR ≥ 1.5 after the first dose of PCC. Logistic regression was performed to determine the predictors of anticoagulation reversal failure.
Fifty-one patients with acute ICH received PCC for warfarin reversal using a weight-based protocol. Overall, 23 (45%) patients did not achieve full reversal of INR after the first dose. Those with anticoagulation reversal failure were obese (body mass index > 30 kg/m(2)) (41% vs. 14%, p = 0.03), had a higher initial INR (3.0 ± 1.4 vs. 2.0 ± 0.7, p = 0.001), and had a higher prevalence of initial INR >2.0 (22% vs. 67%, p = 0.001), compared with those who were successfully reversed. Multivariable logistic regression identified obesity (odds ratio 7.88, 95% CI 1.12 to 55.68) and initial INR >2.0 (odds ratio 12.49, 95% CI 2.27 to 68.87) as independent predictors of anticoagulation reversal failure.
Obesity and elevated initial INR are independently associated with anticoagulation reversal failure using the weight-based PCC protocol in patients with warfarin-related acute ICH. Further studies are needed to determine more effective dosing protocols and individualized strategies for anticoagulation reversal after acute ICH, especially among obese patients.
并非所有华法林相关急性颅内出血（ICH）患者在首次按体重给予凝血酶原复合物浓缩剂（PCC）后国际标准化比值（INR）都能完全逆转。我们试图确定首次给予PCC后抗凝逆转失败的相关因素。
对2010年1月1日至2012年12月31日在一家三级中心因华法林相关急性ICH住院的连续患者进行研究。抗凝逆转失败定义为首次给予PCC后INR≥1.5。进行逻辑回归以确定抗凝逆转失败的预测因素。
51例急性ICH患者使用基于体重的方案接受PCC以逆转华法林作用。总体而言，23例（45%）患者在首次给药后INR未完全逆转。与成功逆转的患者相比，抗凝逆转失败的患者肥胖（体重指数>30kg/m²）（41%对14%，p = 0.03），初始INR较高（3.0±1.4对2.0±0.7，p = 0.001），且初始INR>2.0的患病率较高（22%对67%，p = 0.001）。多变量逻辑回归确定肥胖（比值比7.88，95%置信区间1.12至55.68）和初始INR>2.0（比值比12.49，95%置信区间2.27至68.87）是抗凝逆转失败的独立预测因素。
在华法林相关急性ICH患者中，肥胖和初始INR升高与使用基于体重的PCC方案进行抗凝逆转失败独立相关。需要进一步研究以确定更有效的给药方案和急性ICH后抗凝逆转的个体化策略，尤其是在肥胖患者中。
